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Kenneth L. Maun

Collin County Tax Assessor

REQUEST FOR WRITTEN STATEMENT

Under Tex. Tax Code § 34.015 Regarding Delinquent Taxes

This request will be completed within 10 calendar days

A. Printed name of requesting person/company____________________________________________ B. Mailing address___________________________________________________________________ Phone Number ____________________________ Fax Number ____________________________ C. List all property now owned by you in COLLIN COUNTY or in ANY CITY OR SCHOOL DISTRICT THAT IS LOCATED, AT LEAST IN PART, IN COLLIN COUNTY as follows: Tax Acct. No. 1) 2) 3) 4) [Attach additional sheet if needed] D. List all property formerly owned by you in COLLIN COUNTY or in ANY CITY OR SCHOOL DISTRICT THAT IS LOCATED, AT LEAST IN PART, IN COLLIN COUNTY as follows: Tax Acct. No. 1) 2) 3) 4) [Attach additional sheet if needed] I hereby request that the Collin County Tax Assessor-Collector deliver to me at the address above a written statement under Tex. Tax Code § 34.015 stating whether there are any delinquent taxes owed by me to Collin County or to any school district or municipality having territory in Collin County. The information furnished by me on the form above is within my personal knowledge and is true and correct. _______________________________________________________ Signature and title, if applicable, of Requesting Person Sworn to and subscribed before me, the undersigned authority, on this ____ _______________________, 20_____, to certify which witness my hand and seal of office. day of Legal Description Property Address Date Acquired Date Sold Legal Description Property Address Date Acquired

__________________________________________ NOTARY PUBLIC, State of Texas

REQUEST FOR WRITTEN STATEMENT (9/22/03)

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Microsoft Word - reqwrtnstatement.doc